This page is about waste management at specialized healthcare clinics or facilities: blood banks, obstetric and maternity clinics, outpatient clinics, clinics dedicated to dialysis or transfusion. The range of activities is large, so the waste types and quantities vary considerably from facility to facility.
Waste management includes collection, keeping waste separate from non-waste materials, storing, treating, and disposing of the waste. It is not necessary that all these activities occur where the waste is generated. Off-site storage, treatment, and disposal are common.
Why? Partly to protect the environment and natural world. Partly to protect human populations and society from illness or harm. And partly to protect your own workers. Individuals at risk from medical waste include:
Most (on the order of 80 percent) of the waste generated at clinics is comparable to waste generated at homes and office buildings and often called "general health-care waste". Among waste management professionals, this is called municipal solid waste.
The remaining 20% of health-care waste may pose environmental and health risks. This is where most of your attention as a waste manager should be directed. This is where most of your disposal dollars will be spent.
See our page on types of medical waste. Every facility has its own unique waste profile. Establish the categories you want to manage: pathological, regulated (blood), RCRA hazardous, etc. Do an inventory of the waste you have on site at any time periodically (similar to an accounting balance sheet) and calculate (or estimate) the rate of generation of waste (similar to an accounting income statement).
Most of your waste is regular non-hazardous waste like that produced in any office building. In the waste management profession this is called municipal solid waste (MSW). Avoid mixing it with more dangerous waste (radioactive, RCRA hazardous, biohazardous). MSW is considerably less expensive to dispose of than regulated wastes.
Segregation of waste types is a key tenet of medical waste management.
Institute an integrated and planned collection and storage system. This involves
Establish a room or area in your facility for waste storage. MSW can be stored in an outdoor dumpster until your service carries it off. RCRA waste, radioactive waste, pathological waste, biohazardous waste (treated and otherwise) should be stored in closed containers indoors. Consider the architecture here. The area should be lockable but allow easy access for waste collection vehicles. If possible, you may wish to see if you can get a secondary containment berm or sump in any area with liquid waste. RCRA waste containers must be inspected once a week, and it is a good idea to inspect all regulated waste containers once a week.
Storage areas are usually indoors, although sometimes an outdoor area with a covered awning is acceptable. Indoor areas are easier to keep free of animals and insects. Also, it should be possible to lock the storage area. There should be good lighting and ventilation. If you store RCRA hazardous waste on site, the EPA requires regular inspection of containers for leaks. Even if you don’t store hazardous waste, weekly inspection is a good idea.
Clinics are not allowed to dispose of infectious waste to a sanitary landfill unless it has been rendered non-infectious Some facilities have sterilization on site, using chemical or heat techniques. Others ship waste off-site for treatment. Look at the type and quantity of waste you have and management options in your area to make the best decision.
Radioactive and RCRA hazardous waste is almost always treated off-site, rather than at the clinic. Infectious or biohazardous waste can be decontaminated off-site, but is often treated onsite to remove infection. See treatment page.
Expired blood should not be flushed down the drain. Even if there is no evidence it has been contaminated, it should be disposed of as biomedical waste and sent to an incinerator.
All clinics (and indeed any health care facility of any size) needs to develop and maintain a waste plan. Creating the plan forces you to think through the waste you normally produce and what you do with it. It makes you write down the equipment and facilities you have for storing and treating waste and your relationship with a medical waste disposal company and how often they come to your facility.
Remember the precautionary principle when writing the plan; "When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically."
Given how diverse waste can be, having this overriding principle can help. See our webpage on waste management plans. The plan can be a hassle to develop up front, but in the long run you will probably be glad you have it.
Clinics are no different from non-healthcare facilities when it comes to recycling. By implementing a recycling plan you can cut your MSW disposal costs and maybe generate some goodwill in the community. Check with your local recycle authority about what materials can be recycled. It is common in the US to have a “single stream” recycle system in which all acceptable materials can be put in the same container.
You want to have recycle containers throughout your facility. Make sure they are marked with a recycle symbol, and, if possible, make the recycle containers all the same color. And a different color from the other types of containers in the facility. Dark green is often a good choice if you are not using it for another waste stream.
Some materials that are often recycled are:
Make sure your people know to put only "clean" items in the recycle bins: nothing contaminated with blood or bodily fluids.
In the long run, you may wish to implement a waste minimization program. This requires looking into purchasing practices, and opportunities for using less in your operations. Waste minimization lowers costs for both the purchase of goods and for waste treatment and disposal, and the liabilities associated with the storage and disposal of hazardous waste are also reduced.
See also our page on medical waste management at oncology clinics.